Provider Demographics
NPI:1366033532
Name:THE PROVIDENCE COMMUNITY HEALTH CENTERS INC.
Entity Type:Organization
Organization Name:THE PROVIDENCE COMMUNITY HEALTH CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHARPENTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-780-2511
Mailing Address - Street 1:375 ALLENS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5010
Mailing Address - Country:US
Mailing Address - Phone:401-780-2511
Mailing Address - Fax:401-780-2565
Practice Address - Street 1:434 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3302
Practice Address - Country:US
Practice Address - Phone:888-612-7242
Practice Address - Fax:401-444-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)